A recent report documented that the Veterans Administration has a backlog of 600,000 
disability claims of which 450,000 are more than 125 days in arrears. The reason given for this is the difficulty getting documentation from the military records of the Claimants. Since the DOD uses one electronic medical record (EMR), and the VA uses a different one, and they do not cross communicate between the two systems, it falls to the veteran making the claim to get the records from the DOD and supplying them to the VA for review. Otherwise the veteran has to go through repeated examinations by the VA to obtain the documentation of disability. This problem with EMR’s is not limited to these two agencies. The VA was a forerunner in the use of EMR and the DOD developed its own system after seeing the benefit of the EMR in providing care to the VA. The solution to this problem may be costly at first, but it is too obvious to be adopted by our Governmental agencies. The VA should be allowed access to the DOD EMR database. This should facilitate claims processing and avoid costly delays and costly duplication of medical testing. This assumes that the DOD database is complete, containing all records for each of their patients. Even if it does not contain all documentation, it still might speed things up significantly. I have not been able to identify barriers to this sharing other than cost and stubborn pride.
The problem of cross communication between health care EMR’s is not new, nor is it limited to the DOD and VA. The list of EMR vendor’s is somewhere between 330 and 600. All have developed their software using different databases incompatible with each
other. The biggest problem is the fact that different medical providers have different software needs. Let me try to simplify this final barrier. An orthopedic surgeon needs software that addresses primarily surgical bone and joint problems in detail. An obesity surgeon has no need for most of this detailed data on bone and joint diseases, but needs specific detail on obesity, and the medical problems associated with obesity. A primary care provider needs broader capability with less detail. The only need all providers share is software that documents their efforts sufficiently to justify the medical billing they generate. Medical billing standards have been fostered by payers and are based upon two books used by all, the CPT (Current Procedural Terminology) code book which details and provides numeric codes for almost all procedures performed by all providers, and the ICD-10 (International Classification of Diseases) code book. (Medicare uses a separate coding system, the DRG (Diagnosis Related Group) codes for hospitals which incorporate both diagnosis and procedure.)
In 1987 software standardization for EMR’s called HL-7 was developed to address the problem of cross communication, but there were too many barriers to its adoption, including cost. Recently, licensing of the software standard has been made available at no cost to the user. Yet many software developers have not implemented the HL-7 standards when developing their proprietary software. One of the other problems is that the standard has changed over time, presently existing as Version 3. Since there are so many EMR’s already being used, and many have not adopted the HL-7 standard when they wrote their software, the electronic medical record is anything but portable when a patient moves from provider to provider. There is no solution to this problem that will not require significant cost and effort. If the DOD and VA cannot solve the problem, then why should we expect the private sector to do so when there is no expectation of profitability?
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